Effects of etomidate on complications related to intubation and on mortality in septic shock patients treated with hydrocortisone: a propensity score analysis

Karim Asehnoune,Gerald Chanques,Boris Jung,Julie Carr,Stephanie Nougaret,Samir Jaber,Moussa Cisse,Nicolas Molinari,Noemie Clavieras,Antoine Roquilly

doi:10.1186/cc11871

Karim Asehnoune, Gerald Chanques + Show 8 more

Open Access

https://doi.org/10.1186/cc11871

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Abstract

IntroductionEndotracheal intubation in the ICU is associated with a high incidence of complications. Etomidate use is debated in septic shock because it increases the risk of critical illness-related corticosteroid insufficiency, which may impact outcome. We hypothesized that hydrocortisone, administered in all septic shock cases in our ICU, may counteract some negative effects of etomidate.The aim of our study was to compare septic shock patients who received etomidate versus another induction drug both for short-term safety and for long-term outcomes.MethodsA single-center observational study was carried out in septic shock patients, treated with hydrocortisone and intubated within the first 48 hours of septic shock. Co-primary end points were life-threatening complications incidence occurring within the first hour after intubation and mortality during the ICU stay. Statistical analyses included unmatched and matched cohorts using a propensity score analysis. P < 0.05 was considered significant.ResultsSixty patients in the etomidate cohort and 42 patients in the non-etomidate cohort were included. Critical illness-related corticosteroid insufficiency was 79% in the etomidate cohort and 52% in the non-etomidate cohort (P = 0.01). After intubation, life-threatening complications occurred in 36% of the patients whatever the cohort. After adjustment with propensity score analysis, etomidate was a protective factor for death in the ICU both in unmatched (hazard ratio, 0.33 (0.15 to 0.75); P < 0.01)) and matched cohorts (hazard ratio, 0.33 (0.112 to 0.988); P = 0.04).ConclusionIn septic shock patients treated with hydrocortisone, etomidate did not decrease life-threatening complications following intubation, but when associated with hydrocortisone it also did not impair outcome.

Highlights

Endotracheal intubation in the ICU is associated with a high incidence of complications
In septic shock patients treated with hydrocortisone, etomidate did not decrease life-threatening complications following intubation, but when associated with hydrocortisone it did not impair outcome
We have reported that etomidate use for intubation in septic shock patients treated with hydrocortisone did not prevent short-term life-threatening complications following intubation despite its cardiovascular tolerance profile

Summary

Introduction

Endotracheal intubation in the ICU is associated with a high incidence of complications. Endotracheal intubation, one of the most commonly performed procedures in the ICU [1,2,3], is associated with a high incidence of early onset life-threatening complications (25 to 39%) because of the precarious hemodynamic and respiratory status of those patients [1,2,4]. Because of its potential protective effect on intubation safety [3,4,5,7], due to its cardiovascular properties, and its deleterious impact on adrenal gland physiology [8,28], etomidate may have contrasting impact on the incidence of life-threatening complications occurring within 1 hour after intubation and on the long-term outcome in septic shock patients

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